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Endoscopic Vesicoureteral Reflux Treatment

Submucosal injection of bulking agents at the ureteral orifice to correct vesicoureteral reflux without open surgery.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Üroloji department. Book Appointment →

What is Endoscopic Vesicoureteral Reflux Treatment?

Vesicoureteral reflux (VUR) is the retrograde flow of urine from the bladder into the upper urinary tract due to incompetent ureterovesical junction. It affects 1-2% of the pediatric population, predisposing children to recurrent pyelonephritis and reflux nephropathy with potential renal scarring, hypertension and chronic kidney disease.

Endoscopic treatment involves cystoscopic identification of the ureteral orifice and submucosal injection of a bulking agent—most commonly dextranomer/hyaluronic acid (Dx/HA, Deflux)—at the 6 o'clock position (HIT/STING technique) or directly into the ureteral tunnel. The injection elevates the orifice and lengthens the intramural ureter, restoring the antireflux mechanism.

The procedure is recommended for grades II-IV VUR and is highly effective with minimal invasiveness, rapid recovery and low complication rates. Success rates are 70-90% per ureter, with higher rates for lower grades. Failure or recurrence may require repeat injection or definitive ureteroneocystostomy. Continuous antibiotic prophylaxis is reduced or discontinued after successful treatment.

Symptoms

Recurrent febrile urinary tract infections
Pyelonephritis episodes
Antenatal hydronephrosis
Renal scarring on DMSA scan
Hypertension in children with VUR
Failure to thrive
Voiding dysfunction
Lower urinary tract symptoms
Family history of VUR
Asymptomatic VUR detected during workup

Risk Factors

Female sex (in childhood)
Family history of VUR
Bladder bowel dysfunction
Antenatal hydronephrosis
Recurrent UTIs
Posterior urethral valves
Duplex collecting system
Spinal dysraphism
Constipation
Recurrent pyelonephritis

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Febrile UTI in young children
  • Hydronephrosis on prenatal or postnatal ultrasound
  • Recurrent UTIs despite prophylaxis
  • New renal scarring
  • Failed continuous antibiotic prophylaxis
  • Family history requiring screening
  • Voiding dysfunction with reflux
  • Pyelonephritis with anatomic abnormality

Treatment Methods

01
Voiding cystourethrogram (VCUG) for grading
02
DMSA scan for renal scarring assessment
03
Continuous antibiotic prophylaxis when indicated
04
Bladder-bowel dysfunction treatment
05
Endoscopic submucosal Deflux injection
06
HIT or double-HIT injection technique
07
Postoperative DMSA and ultrasound follow-up
08
Repeat injection in failed cases
09
Open or robotic ureteroneocystostomy in refractory cases
10
Long-term renal function and blood pressure surveillance

Which Department to Visit?

You can visit our Üroloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.